Hospital Dr News

Churn in senior NHS leadership roles negatively impacting on the performance of trusts

A near-toxic mix of pressures facing NHS organisations, coupled with a culture of blaming individual leaders for failures beyond their control, means NHS trusts are facing significant difficulties in recruiting and retaining senior leaders.

That’s the conclusion of a report from The King’s Fund and NHS Providers, based on an analysis of survey data from 145 trusts.

It shows that 8% of executive director posts are vacant, and 37% of trusts have at least one vacant executive director role, with director of operations, finance and strategy roles having particularly high vacancy rates or short tenures.

The report calls this an ‘inverse leadership law’, where high levels of vacancies and turnover rates affect the organisations with the most significant performance challenges.

In trusts rated as ‘outstanding’ by the CQC, only 3% of posts were vacant and 20% of executives had been appointed within the past year (2017), while trusts rated ‘inadequate’ had 14% of posts vacant and 72% of executives had been appointed in 2017.

Overall, the median tenure of a chief executive is just three years. Short tenure was a concern for all executive director roles, but a particular problem for chief operating officer roles.

Other research shows that a high level of churn in leadership roles has a significant negative impact on the culture and performance of trusts.

Leaders interviewed for the report also suggested it results in short-term decision-making, which can paralyse organisations at a time when they should be moving forward to develop new ways of delivering care.

NHS leaders interviewed for the report viewed their jobs as both a vocation and a privilege. However, they highlighted an increased risk of regulatory ‘decapitation’, suggesting that consequences of poor performance or failure are perceived to be increasingly ‘personalised’ and laid at the door of individual leaders by some national bodies, politicians and the media.

This can lead to a greater unwillingness to take on these challenging roles and can discourage bold leadership once in a role.

Saffron Cordery, Director of Policy and Strategy and Deputy Chief Executive at NHS Providers, said: “We know that high turnover among chief executive and other board-level roles has a negative impact on the culture and performance of NHS trusts. It is no great surprise that the best-performing trusts often have stable leadership in place over many years.

“It therefore can’t be right that our most challenged organisations continue to experience the biggest difficulties in recruiting and retaining leaders. We need a new approach to supporting the most challenged trusts and systems to develop their leaders rather than continuing with a revolving door approach.”

The report calls on the national bodies to take action to address leadership vacancies and cultures that deter experienced staff from taking on these roles. It says responsibility for leadership has to be spread across the system, and that an overly centralist approach will not work.

It suggests that rebuilding the regional talent management functions previously performed by strategic health authorities should be a priority for the new joint NHS England and NHS Improvement regional teams. National leadership development programmes should also expand their focus to include those board roles that are particularly difficult to recruit to.

Niall Dickson, chief executive of the NHS Confederation, said: “The challenges facing the health service in the coming decade are enormous – we need a good pipeline of strong, effective leaders who feel confident about themselves and will inspire and empower their staff.

“If we look after and support them they will do the same with their staff who in turn will do the same for their patients.”

Read the full report.

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